Treating recurrent prostate cancer with lymph node surgery

The authors aimed to determine the long-term outcomes of lymph node surgery in patients who experienced prostate cancer recurrence after prostate surgery.

Prostate surgery involves surgically removing the prostate gland in patients with prostate cancer. In some cases, following surgery, some patients may experience cancer recurrence. Lymph node surgery can be used as an alternative treatment in cancer recurrence. This involves surgically removing the lymph nodes (sites that hold the immune cells) to prevent cancer spread. 

The aim of this study was to determine the long-term effects of lymph node surgery in patients with recurrent prostate cancer.

59 patients were used in this study with an average follow-up time of 81.1 months. 79.6% of patients had cancer in their lymph nodes at the time of surgery.

59.3% of patients experienced biochemical recurrence (prostate specific antigen levels were elevated in the blood after treatment indicating prostate cancer recurrence (PSA – protein elevated in the blood when prostate cancer is present)) after lymph node surgery. The 8-year biochemical-free survival rate (patients who did not experience biochemical recurrence after treatment) was 22.1%.

57.6% of patients experience clinical recurrence (diagnosis of cancer recurrence indicating treatment failure) and 13.6% experienced cancer-specific mortality (patients who died from prostate cancer following treatment). The 8-year clinical recurrence-free survival rates (patients who did not experience cancer recurrence after treatment) were 38.2% and the 8-year cancer-specific mortality-free survival rates (patients who did not die from prostate cancer following treatment) were 80.6%.

Patients who had a PSA level of less than 4ng/ml had a 8-year clinical recurrence-free survival rate of 43.8% compared to 23.5% in patients with a PSA level greater than 4ng/ml. Patients who had positive lymph node results (cancer was present) had a 8-year clinical recurrence-free survival rate of 20% compared to 44.8% in patients with negative lymph node results. In patients who had positive lymph node results, those who had retroperitoneal tumors (tumors in the abdomen tissue that surrounds vital organs) had an 8-year clinical recurrence-free survival rate of 22.4% compared to 68.7% in patients without retroperitoneal tumors. Patient who had more than 2 positive lymph nodes had an 8-year clinical recurrence-free survival rate of 28.3% compared to 63.2% in patients with two or less.

PSA was identified as an independent risk factor in clinical recurrence where patients with higher PSA levels had an 8% increased risk of experiencing cancer recurrence. Biochemical recurrence and the presence of retroperitoneal tumors were also identified as independent risk factors.

The authors concluded that lymph node surgery is a viable treatment option in patients who experience cancer recurrence after prostate surgery. 

Results may be biased as there was no control group used to allow for comparisons in patients who did and did not receive lymph node surgery. 

If you are considering lymph node surgery as a possible treatment, please consult your doctor for potential risks and benefits.